by Kim Painter, Special for USA TODAY

by Kim Painter, Special for USA TODAY

Women who survive heart attacks may suffer even greater emotional fallout than men who do, a new Gallup Poll suggests.

Heart attack survivors of both genders report more sadness, worry and stress and less enjoyment in life than people who have not had heart attacks, but the gaps are bigger for women, according to results from 353,492 interviews conducted in 2012. The interviews were part of an ongoing, daily poll, the Gallup-Healthways Well-Being Index, which tracks the nation's emotional temperature.

More than 11,000 male heart attack survivors and 6,000 female survivors answered questions about how they felt and what they experienced the day before they were polled, says Lauren Besal, a Gallup research analyst.

Those survivors scored significantly lower than other adults on a 100-point scale of emotional well-being - with male survivors scoring 77 and female survivors scoring 73, compared with 81 for other men and women. The gaps were bigger for women than for men when it came to sadness, worry, stress, pain and diagnosed depression (with 35% of female survivors and 24% of male survivors reporting a diagnosis). These happiness gaps existed for women at every income level, but not for men making more than $90,000 a year.

The poll had a margin of error of about 1 percentage point.

The results do not prove that heart attacks cause more emotional upheaval in women. It's possible that women who have heart attacks and survive them are even more likely than men to have had emotional problems before their heart problems began, Besal says. "Whether one came before the other we cannot tell."

But the findings might mean that "social support as a part of treatment may be especially important for women," she says.

Suzanne Steinbaum, a cardiologist at Lenox Hill Hospital in New York, agrees: "This could be a crucial wake-up call."

The relationship between emotional and heart health is complex, she says, but research shows that "when people have heart disease, and they have depression on top of this, they don't do as well."

Women who survive heart attacks may be more despondent because "a lot of times, women are sicker after they have a heart attack," she says, possibly because they wait longer than men to get medical help for warning signs such as chest pain and shortness of breath.

Women may also face extra stresses "because we are the caretakers of our families," says Amy Heinl a 43-year-old banking executive from Pittsburgh who had a heart attack in June 2010. Heinl, who is a divorced mother of three boys ages 12 to 17, says she "was scared for a year" after her attack, which was especially dangerous because it was caused by a torn artery. "Any pain or tweak I felt, I thought was my heart," she says.

Today, she's optimistic and doing well, but, she says, "I still think about it every day."

Steinbaum and Heinl are spokeswomen for the American Heart Association's Go Red for Women campaign, which raises awareness about heart disease as the No. 1 killer of women.

While women are less likely than men to have heart attacks, they are more likely to die from them, the association says. About 370,000 women and 565,000 men in the United States have heart attacks each year; 26% of women and 19% of men having a first heart attack die within a year. About 4.8 million men and 3.1 million women in the United State are heart attack survivors.